Outstanding Numbers

Good Morning.

"Outstanding Numbers" has two meanings: The first, of course, is that in spite of everything--the terrible website launch of HC.gov and some of the state sites; the still-terrible status of some of the state sites even now; the actively-hostile opposition and obstructive actions in certain states, the negative spin on every development by some in the news media--in spite of all of this, over 7 million people nationwide enrolled in private, ACA-compliant healthcare plans between 12:01am on 10/1/13 and 11:59pm on 3/31/14...slightly surpassing the original CBO projection for that period.

There's the usual discussions about "But how many have PAID???", "But how many were ALREADY INSURED???", "How many were YOUNG???" and "What METAL LEVEL did they get???" etc etc etc. All of these are reasonable questions for actuaries, accountants and so forth to ask, and the answers will indeed help shape our understanding of what the overall economic and health impact of the law will be.

For the moment, however, none of that matters. This is an outstanding number any way you slice it.

On a more practical level, I'm using the other meaning of "outstanding". That is, the enrollment data which has yet to either occur or which has already occurred but hasn't been documented yet.

The former, of course, refers to the enrollment "extension period", which is 15 days in most states, but which actually runs until April 30th in Oregon (without any "started by 3/31" requirement that I can see) and even all the way out until May 30th in Nevada (with the "3/31 start" requirement). Only 3 states (CT, RI and WA) aren't offering any extension period at all, and I'm not entirely sure about Rhode Island as their press release was a bit confusing. I also have no idea know what the status of Hawaii's exchange is.

Of course the 2nd open enrollment period kicks off again this November, but there's also the other types of enrollments which haven't ended, even for the current year.

  • Medicaid has no cut-off date; if you qualify, you can enroll at any time.
  • The SHOP exchanges (small business) don't have a cut-off date. Most of them still aren't functional (only about 70,000 people are covered by SHOP policies so far nationally), but some are, and they're year-round.
  • If you're one of the 5.2 million Native Americans living within the U.S., there's no cut-off for you either.
  • Finally, for the rest of us, you can still enroll in an exchange-based QHP if you have a major life event such as getting divorced, giving birth, losing your job and so on.

This covers the "has yet to occur" part noted above. How about the "hasn't been documented yet" part?

Well, you see, in addition to the monthly HHS Exchange Reports which eveyrone knows about (these are the ones with the Exchange QHP numbers that get all the attention), there's also another one which also comes out monthly: The CMS Report. This contains Medicaid, CHIP and other sundry public healthcare program enrollment data from traditional means--that is, people simply walking into a state Medicaid office and applying the old-fashioned way, without going through the official exchange website (although in some cases it includes that as well, which is part of why tracking this data is such a royal pain...I have to be careful not to double-count the data).

The HHS reports have been coming out around the 11th or 12th of the following month, The CMS reports, on the other hand, are so complicated (there's no uniform standard for reporting it...some states report households instead of individuals; some mix new enrollments with renewals of existing accounts and so on) that they don't usually come out until near the end of the following month...and sometimes not even then. In this case, the February CMS report still hasn't been released, and may not be until later this week. Given the insanity over the past weekend, it's possible that it will even be delayed into the week after that.

How much does this impact the spreadsheet and graph? Well, it doesn't change the Private QHP side at all, of course, but it could potentially bump up the Medicaid/CHIP side by quite a bit...perhaps a half million or more, depending on how the "strict expansion" and "woodworker" estimates come out.

Then comes the official March HHS Report, which will include most of the Big Surge. This won't increase the exchange QHP total at all, it will just clarify it, giving specific numbers and (most importantly) breaking it all out by state. It will also include another chunk of Medicaid/CHIP data, which will increase that number even more--possibly by another million or two, I'd imagine.

You'll note that I said it will include "most" of the March surge. Why not all of it? Well, as I've noted earlier, the other HHS reports don't necessarily end exactly on the last day of the month--they go by the calendar week, not the calendar month. I don't know why, but for whatever reason the HHS reports all end on whatever Saturday is closest to the end of the month. This is why the January report actually included the last 3 days of December and the first day of February...and ended up covering 5 weeks (35 days), while the February report only included 4 weeks (28 days), and ended on March 1st.

You see the potential problem here: It's possible that the March HHS Report may not include Sunday or Monday, the two busiest days of the open enrollment period! If HHS decides to lop those 2 days off until the April report (which would be incredibly stupid, but which they may have to do...I don't know what the HHS reporting regulations are), then there will be up to 400,000 QHP enrollments missing from the report! They'll show up in the following month's report, of course, along with all of the extension period additions (which could be a good half million to a million more, for a total of 8M+), but in the meantime FOX News will have a field day with their "cooking the books" nonsense.

Anyway, hopefully HHS will make an execption on this report and include the 30th and 31st as part of March after all...or, at the very least, make it very, very clear that the last 2 days of the month will be included in the April report for purely procedural reasons.

Finally, after that comes the March CMS report with whatever Medicaid/CHIP additions it has (which could be yet another half-million or so added to the tally).

Then, sometime in May, the April HHS Report will be released...and that should include the (half million? 1 million? more?) QHP enrollments racked up during the current extension period...which still won't be the final number, since Oregon and Nevada will still have a few stragglers rolling into the May report...

And then, on November 15, the whole thing starts over again.

Outstanding numbers indeed.